"Health Care Economics in the U.S. and Abroad" by Allen Weiss, MD, CEO & President

April 1, 2008 - A major concern for all Americans today is the cost of health care. In 2006 health care expenditures in the United States rose 6.7%, according to a recent New England Journal of Medicine article. Currently, we spend about $6,700 per person per year and yet we do not have the longest life spans or lowest mortality rates of the world's developed nations.

Total health care spending now accounts for over 16% of the Gross National Product (GNP). Predictions are that this percentage will grow to 20% in seven years and precipitate a crisis resulting in a redesign of how we deliver health care in America.

Why does this matter to all of us? If we are not as efficient as other countries in this new era of a global economy, the United States will fall behind in creating wealth for our nation. An example of this is in the automobile manufacturing business. Currently the major American manufacturers spend about $1,500 of the retail price of each new vehicle on health care for their workers. Some of the major foreign manufacturers spend about half that amount. This dramatic disadvantage has had a strong negative effect on market share for the domestic manufacturers resulting in further economic turmoil for their communities.

This medical inflation has been attributed to many factors: an aging population, new technologies, poor personal habits (lack of exercise, over eating, smoking), excessive litigation, and excess supply of medical products and services that can induce more demand if there is no personal accountability.

Most developed countries face these same challenges yet in many of them the population has a longer lifespan and better overall health care measures. Surprisingly, Greece spends only about $670 per person per year and they are always in the top ten countries for overall quality. The United States, unfortunately, is not.

France is consistently given credit for having the best overall health care. What do they do that we don't? They pay people to go for care to prevent illnesses. For instance, pregnant women are paid when they make appointments for pre-natal care. Smokers are paid to go to smoking cessation courses, with additional stipends if they stop. This is a novel approach and although it takes away personal responsibility, the rewards idea seems to work.

Physicians and hospital systems are rewarded for treating sickness, but not for encouraging wellness. The NCH Board of Trustees has taken a significant step toward promoting wellness by operating two Wellness Centers—the Whitaker Wellness on Immokalee Road and the Briggs Wellness Center on the Downtown Campus. Both currently have about 5,000 members and are busy every day from opening until closing. Since we can prevent 70% of all illnesses by taking better care of ourselves, these centers and others should help to keep overall health care costs at a more reasonable level.

Going forward, we all need to squeeze out inefficiencies while being personally responsible for our health, if we want to control rising costs. Just stopping the use of tobacco products would immediately save 20% of health care expenses. Eliminating waste will be the ticket to win the cost battle and increase value for us all.

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.